in determining the similarity of causes in the case of human disease. His scientifically trained mind was also well prepared to seize upon and demonstrate the ways in which these microbes or germs can be transmitted from place to place, as well as the conditions most favorable to their transmission. This opened up a new field to medical research, and since that time many of the efforts for public health have been in the direction of isolating disease, preventing its spread, and of giving it no opportunity for growth. His discoveries also prepared the way for isolating disease germs and for experimenting with them with a view of discovering the best means of counteracting their effects and of preventing their attacks. By artificial cultivation of colonies of an isolated germ it has been possible to inoculate animals and reproduce the disease within them. This has made feasible the scientific observations and experiments that have been the chief means for the past thirty years of discovering the best remedial and preventive measures for some of our most fatal diseases. Although the suffering thus entailed on the animals used in the experimenting is to be deprecated, it has been justified on the ground that the necessities of the case demand it; besides, the saving of even one human life would justify the sacrifice of many animals. At least, it cannot successfully be denied that such experimentation has been the means during the last thirty years of a progress in matters of health greater than during all the preceding centuries. This progress has been particularly marked in the way it is removing the terror and hopelessness of disease. The more we know of the nature of a disease and of its cause, the more hopeful the outlook for its prevention and cure. Much of the old-time terror in regard to disease was inspired by the mystery surrounding it and the resulting feeling of helplessness in attacking it. Curative remedies that are not based upon an exact knowledge of the nature and cause of disease are subject to all the vicissitudes and errors of all other merely observational knowledge.

There is a strong feeling developing among practitioners against giving any medicine for the cure of disease, excepting such as absolute experiment has demonstrated to be a specific against the encroachment or development of the

disease. This has led to far less use of drugs than formerly, and it is claimed that still fewer would be given were it not for the clamor of patients for something to take whenever their physical mechanism is not running smoothly. Besides the injury that may be wrought by the extensive use of drugs, there is the additional danger arising from the incomplete or hasty diagnosis of the physician who feels that a case is not serious enough to warrant careful investigation. Curative measures that will command the confidence of the public will ultimately have to embrace a care and evidence of knowledge in the diagnosis that will inspire confidence, whether the verdict is medicine or no medicine. But whether the ailment be slight or serious, whether it be real or largely imaginative, the patient is probably on the safe side in appealing to his physician at once in regard to a continued ailment; for too often this appeal is made after the disease has gained such headway as to render the result doubtful and the prospect hopeless. The most favorable results, especially in contagious diseases, are always to be secured from early and prompt treatment. And such insidious diseases as tuberculosis are no longer greatly feared if recognized and treated in their early stages. At least such is the evidence of the records and the statements of the medical experts upon whom we must rely.

But the greatest change in the attitude toward disease is noticeable in the changed view concerning the functions of the physician. The distinguished physician, Earl Mayo, calls attention to this in an article in the Outlook for July 20. Medicine, he says, has heretofore been looked upon as "the healing art," and the business of the physician to be to make us well when we are sick. As our habit has been to give very little heed to our physical state except when we receive unmistakable warning that it is badly deranged, this ideal has been forced upon medical men as a guide of conduct irrespective of any views that they themselves might entertain." But all this is changing. The principal business of the physician of the future will be to keep us well. The evidence of this is to be found in the activity of boards of health in removing sources of disease, in the popular demand for the kind of information and leadership that will promote physical well-being, and in the

emphasis being placed on this phase of medicine by leading physicians, lecturers, magazine articles, etc. This change of attitude toward the function of the physician is manifesting itself especially along the lines of

(a) Emphasizing his duty to be that of leading the people into such a knowledge of the nature, causes, and means of preventing disease as will enable them to avoid its ravages.

(b) Through his researches to gain such a knowledge of the nature of each specific disease as will enable him to detect with surety its presence in its earliest stages, so that the proper remedial measures may be adopted in time.

(c) To do all in his power to remove the alarming mystery that is so often associated with disease and which certain types of medical practitioners are tempted to foster for the sake of magnifying their own services.

(d) Believing that, after all, nature knows best how to combat its own ailments, to seek "to know and to emulate the methods by which nature (meaning in this case the accumulated experience of the bodily organs throughout their entire history) fights disease and tries to overcome it." It is on this side-in the field of experimental medicineDoctor Mayo says, that the most wonderful advance of recent years has been made. "It is the work that has been done in this field that has given us a new outlook, a new hope, a new attitude, and in many cases new methods in facing and treating serious bodily ills."

(e) The corollary of this will naturally be the giving of less medicine and the calling out more and more of the suffering individual's intelligent and persistent efforts in his own behalf. Such a course will have the double advantage of arraying his own will power and intelligence against the further encroachments of the disease, and of fostering physical foresight and practices that will probably do more than anything else to promote progress in matters of health.

(f) To be a student of human nature so that he may be able to call forth a helpful mental attitude not only in the afflicted individual but in the public at large. Professional people have given little consideration to this phase of their work, and, as a result, have missed much of the help that comes from mutual understanding and confidence between

doctor and patient, lawyer and client, teacher and pupil, the leader and the led. Sarcasm and invective never prove as effective against false doctrines, selfish leadership, and the harm that comes from indifference and neglect, as do persistent and tactful campaigns to secure the intelligence and confidence that tend to remove the opportunity for such things.

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(g) And, finally, that the physician shall be an apostle of right living, not merely in the avoidance of disease but in securing the fullest development of mind and body. Men are learning slowly, very slowly, as all great lessons are learned, that a sound body is their best defence; that excesses—whether of work or any other kind—are inevitably weakening; that pure air and exercise, moderation in eating and drinking, and generally correct habits can do for them what no amount of dosing with drugs can ever do." And this right living includes right thinking as well as right acting. Whatever may be the nature of the mind, it is so closely connected or interrelated with the body that its well-being enters deeply into the account. This broadens the field of the physician's work and makes him touch shoulders with education and all the other social forces in his efforts. Like the educator, no matter how limited his field of special effort, he will never get the best results from it without intelligently and sympathetically grasping its place in the larger interests of which it is an integral part.

It is quite clear that the most promising results for public health can be gotten only by beginning early in life, -in fact, with the parents even before the birth of the child. American statistics indicate that fully one-third of the babies born die before they reach the age of five years and that, in any single year, from one-fifth to one-fourth of the entire death-roll is made up of infants less than a year old. And the physical risks that the remainder run because of the neglect, ignorance, bad judgment, and weakness of parents and others is not pleasant to contemplate. As a writer in McClure's for August well says, why should we worry about a declining birth-rate when more babies are born merely to die? And why should we be anxious to save their lives if they are only to swell the great army of

the defective and diseased? No line of interest is of more importance to the physician and the educator than this, and it is significant that the mind of the public turns more and more each year toward this more promising field of work. But nothing, after all, means so much for the public health as the attitude of hopefulness that is slowly replacing the old feeling of hopelessness and helplessness in the presence of disease. Even the idea that it is "God's will" offers little comfort to pious people who see their loved ones cut off in the prime of their usefulness. "To-day we know that it is not God's will' that children should die of diphtheria or young men be destroyed in the flower of their manhood by typhoid fever. We are awake to the fact that it is man's ignorance or man's carelessness that is responsible, and we are inspired to work on toward the glorious ideal set before us by Pasteur when he said, 'It is within the power of man to cause all infectious disease to disappear from the earth.'

The Newer Medical Education.

This changed attitude toward disease has not only made new demands upon the medical profession, but it has also made necessary new ideals and a change of emphasis in the training of physicians. While the older education emphasized the knowledge and text-book phase of medical training, the newer is insisting upon the importance of trained observation and the laboratory method. It is not that knowledge is not important, and a large amount of it even necessary, but that study and practice must be permeated by the newer spirit which recognizes that so little of absolute fact is known and so much of new insight is possible that every practitioner, worthy the name, must prepare himself for being an intelligent observer and a possible discoverer. There never has been a time when professional men were so thoroughly permeated with the spirit of questioning existing practice, of investigating, testing, and observing for the finding out of new truth, as they are to-day. There also has never been a time when the people were expecting and even demanding so much from their experts as to-day. It is to such influences that